Flu Vaccine 2014: The New ACIP Recommendations

Sandra Adamson Fryhofer, MD


September 24, 2014

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Editor's Note: In a press release issued on October 30, 2014, the manufacturer of Flublok® influenza vaccine announced that the FDA had expanded approval to all adults aged 18 years or older, including those with any degree of egg allergy; it was previously approved only in adults 18-49 years.

Hello. I'm Dr Sandra Fryhofer. Welcome to Medicine Matters. The topic: Flu protection 2014—what is best for you? The latest update from the Advisory Committee on Immunization Practices (ACIP) is now published in MMWR.[1] Here is why it matters.

Each year, ACIP updates its recommendations for seasonal influenza vaccination. Everyone 6 months of age or older needs vaccination every year. That hasn't changed. Neither has the antigenic formulation for 2014-2015. It is the same as last year's. The recommendation as to when to start vaccinating—as soon as vaccine becomes available—has also not changed, but this year's update contains some qualifying statements you need to know about.

Vaccine manufacturers are now delivering vaccine earlier and earlier. That is a good thing. But after vaccination, antibody levels start to decline. A case-control study showed a significant antibody decline in those 65 years or older. At 6 months post-vaccination, the decline is significant in seniors 65 or older.

No flu season is the same. It is impossible to predict when flu season will peak. Although the new ACIP guidelines stop short of specifying a specific date for vaccinating, please use common sense. On the other hand, deferring vaccination and thus missing a vaccination opportunity is also not a good idea. We have lots of people to vaccinate—everyone 6 months and older—and there is a plethora of flu vaccine choices but, basically, only three classes of flu vaccine.

Inactivated Influenza Vaccine

First, the inactivated influenza vaccine (IIV), available as:

The old-fashioned standard shot;

An intradermal version using a really small, skinny needle only for adults up to age 64 years;

A high-dose version only for seniors 65 years or older; and

A new cell-cultured version (CCIIV) for adults of all ages.

These inactivated shots can be given to age-appropriate patients with hives-only egg allergy.

Also new for this season: needle-free flu shots. PharmaJet® needle-free injection technology has teamed up with flu vaccine manufacturer bioCSL. This needle-free injection system (brand name Stratis®) can be used to administer inactivated flu vaccine, Afluria®, to adults 18-64 years old.

Recombinant Influenza Vaccine

Next, one of the newest flu vaccines on the market: the recombinant influenza vaccine (brand name Flublok®), abbreviated RIV3. The "3" means that it is trivalent. This is totally egg-free and can be given to patients aged 18-49 years, including those with egg allergy of any severity.

Live Attenuated Influenza Vaccine

And finally, the live attenuated influenza vaccine, abbreviated LAIV4; the "4" means that it is quadrivalent. It is made from live but weakened virus. It is only for healthy people aged 2-49 years, as long as they are not pregnant. This year, LAIV got an additional heads-up from ACIP for use in young children. Evidence review found LAIV to be more efficacious than inactivated flu vaccine among younger children. ACIP now recommends LAIV for healthy children aged 2-8 years. There is a qualifier. Flu vaccination should not be delayed. If LAIV is not immediately available, it is fine to vaccinate with IIV, the inactivated vaccine. LAIV should not be given to anyone with a history of egg allergy of any severity.

For more information, check out ACIP's full influenza guidance statement in MMWR. There is also a great, handy table with a list of all of the different vaccines, their abbreviations, manufacturers, and age indications. So check it out, and happy vaccinating.

For Medicine Matters, I'm Dr Sandra Fryhofer.


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